A Therapeutic Window for Platelet Reactivity for Patients Undergoing Elective Percutaneous Coronary Intervention

Abstract

A therapeutic window for platelet reactivity measured with the VerifyNow P2Y12 assay can be identified using specific thresholds that define a group of patients at lower risk for both ischemic and bleeding events. Adjunctive measures may be beneficial in patients with higher or lower platelet reactivity in order to improve clinical outcomes after PCI.

Incremental Value of Platelet Reactivity Over a Risk Score of Clinical and Procedural Variables in Predicting Bleeding After Percutaneous Coronary Intervention via the Femoral Approach

“…Hyporesponders to antiplatelet therapy have high PR and therefore increased risk of thrombotic complications 17,20,29 ; on the other extreme of the spectrum, hyperresponders present low residual PR and therefore increased risk of hemorrhagic complications. 18,19,30 Using the VerifyNow P2Y12 platelet function test, we have recently proposed a threshold of 178 PRU for the definition of LPR, 21 which was associated with a significant increase in 30-day bleeding in patients undergoing elective PCI. Moving from the evidence that both clinical risk scores and PR could predict post-PCI bleeding, we have investigated whether the combination of these parameters could improve their prognostic performance.…”

“…28 A bleeding risk score including PR (BRS-PR) was then developed in the study population and validated in the cohort of patients enrolled in the Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty-Bleeding Study (ARMYDA-BLEEDS) study. 18 Besides clinical and procedural variables composing the BRS, low PR (LPR), defined as a PRU value ≤178, 21 was also included in BRS-PR. Both BRS and LPR were entered in a multivariable logistic regression model to identify independent predictors of TIMI bleeding.…”

“…21,22 Specific thresholds of PR have been identified as associated with a significant increase in the incidence of bleeding complications, helping to identify patients at higher hemorrhagic risk. In particular, we have recently proposed a threshold of 178 P2Y12 reaction units (PRU) measured with the VerifyNow P2Y12 assay to predict bleeding events after PCI.…”

“…In particular, we have recently proposed a threshold of 178 P2Y12 reaction units (PRU) measured with the VerifyNow P2Y12 assay to predict bleeding events after PCI. 21 However, at present, none of the risk scores for bleeding consider PR among variables for risk assessment.…”

Management of Concurrent Severe Preeclampsia and Thrombotic Thrombocytopenic Purpura (TTP)

“…TTP is a rare complication of pregnancy with a poor prognosis and high fetal mortality, especially when it occurs during the first trimester [2]. But most of TTP cases occur in the late trimester of pregnancy.…”